23-year-old gave scant thought to skin cancer, then he noticed dark mole

May 24, 2015
| by Samantha Bona

“Skin cancer” was pretty much the last thing on the mind of a healthy, outdoorsy kid like Tanner Harbin.

College student and skin cancer patient Tanner Harbin now gives much more thought to sun safety. That wasn't the case before his diagnosis with a rare form of cancer.

“I like hockey – playing it and watching it,” the 23-year-old from San Dimas said. “I like to go off-roading with my dad – we have a Jeep and we have a cabin up in Big Bear, so we go up there and do stuff like that.”

When he’s not palling around with his dad, Harbin works at an Ace Hardware and goes to Mt. San Antonio College, where he’s studying to become a welder. “I’m pretty much always at work or at school,” he said.

Other than a bout with teen acne, Harbin had never given a lot of thought to the health of his skin. “I don’t think most people my age ever even think of going to the dermatologist,” he said. “They don’t even think about using sunblock. They just stand out there getting burned. They go to tanning booths. My sister used to do that. She stopped when I started having problems with my skin.”

Those “problems” began with a dark black mole Harbin first noticed on his back last December.{C}

The first sign of a problem

“I’d never seen it before. My parents had never seen it before either, so they thought I should get it looked at,” he recalled. He went to his dermatologist, who checked Harbin's records and found no mention of the mole at his last visit a year ago — it had cropped up suddenly sometime in the last few months.

The dermatologist removed the mole in January, then called Harbin a couple weeks later and asked him to come in. “They weren’t really sure what it was,” Harbin said. “He recommended that I go to City of Hope.”

Dermatologist Jae Jung, M.D., Ph.D., was the first doctor Harbin met at City of Hope, in mid-February. “She looked at the slides and said it was weird-looking,” Harbin recalled. The cancer was unusual; that much was certain. Jung proceeded to get second opinions from other dermatologists at City of Hope, then to go over the case with the City of Hope Tumor Board, which meets once a month to discuss patient cases.

Together the team of oncologists, surgeons, pathologists and dermatologists made a diagnosis and came up with a treatment plan.

“Tanner had a very, very rare melanocystic neoplasm,” Jung said. “It’s not quite melanoma, but it’s not benign. There is a distinct overlap between this melanocytoma and what used to be called animal-type melanoma. And some percentage of them do metastasize. But it’s really unclear how much overlap there is because they’re so rare.”

The official name of Harbin's tumor is PEM (pigmented epithelioid melanocytoma). Doctors aren’t sure if such tumors – more commonly seen in animals such as horses – are genetic or caused by sun exposure, or some combination. In general, the prognosis for this highly unusual melanoma variant is good.

“That’s why this was an important case to discuss in a multidisciplinary fashion,” Jung said. “It was a discussion of experts on this very, very rare subset of cancers. ... You don’t want to just dismiss it as being rare and then not deal with it in an inappropriate way: ‘We don’t really know what it is so let’s just watch it and see what happens.’ Things like that happen not infrequently at community hospitals. Then by the time we see it here it’s metastatic.”

That team approach is what sets City of Hope apart, Jung said. “There’s always someone available in medical oncology or surgical oncology or pathology that you can discuss something with, so you’re not just kind of an island,” Jung added. “You don’t want to do the wrong thing for a patient, particularly when it’s ultrarare.”

A treatment, and follow-up, plan for life

In Harbin's case, “they said if they left it in, it could turn into cancer and spread," Harbin said. "They took a huge area out of my back — the incision was about six inches long."

City of Hope surgeon Hans Schoellhammer, a melanoma expert, performed the surgery and also removed one lymph node. “He actually did a really good job on the stitching,” Harbin said. “It looked pretty red and swollen and gross the next day, but now it’s pretty much completely flat. He did a very good job for the size that he took out.”

Harbin did not require chemotherapy or radiation, but he will need to go back to City of Hope every three months for rechecks for the next two years. Also, “I can never go in the sun unless I wear sunblock now,” he said.

Jung will take over as his dermatologist for life. And because there is now a family history of melanoma, as well as pancreatic cancer – recent research has shown links between the two – Harbin's older sister, Chelsea, will get checked by Jung from now on, too.

Harbin is fine with regular checkups, saying the pleasant atmosphere at City of Hope helped take the sting out of his diagnosis.

“Everyone was very nice, very caring, always smiling and in a good mood. You kinda need that in a place like that," he said. "You can’t have everyone going around with a frown on their face.”